Elbow and Forearm Common Clinical Presentations Flashcards
(100 cards)
1
Q
INTRO
A
INTRO
2
Q
What are the general health conditions that will be talked about in regards to the elbow and forearm?
A
- Fracture and Other Bony Abnormality
- Pediatric Elbow Conditions
- Elbow Instability and Collateral Ligament Sprain
- Olecranon Bursitis
- Tendinopathies and Epicondylopathies
- Distal UE Nerve Entrapments and UE Nerve Palsies
3
Q
FRACTURES/BONY ABNORMALITIES
A
FRACTURES/BONY ABNORMALITIES
4
Q
What are some fractures/other bony abnormalities?
A
- Heterotopic Ossification
- Radial Head Fracture
- Monteggia Fracture
- Panner’s Disease
- Olecranon Fracture
- Nurse Maid’s Elbow
5
Q
What is heterotropic ossification?
A
When we get bone formation in areas where there shouldn’t be. Bone integration into soft tissue.
6
Q
Heterotropic ossification can be both ___________ or painful. It can also progress to ________.
A
- asymptomatic
- ankylosis
7
Q
Radial Head Fractures and Dislocations:
- Common MOI: ________
- Isolated to radial head, proximal forearm, or combined plexus.
- Check for concomitant injury at the _______ and __________.
- Also check for concomitant __________ compromise.
A
- FOOSH
- wrist and upper arm
- neurovascular
8
Q
What is the symptom of radial head fractures and dislocations?
A
local pain
9
Q
Radial head fractures are divided into __ types and can have comminution, what is this?
A
- 3
- More than 2 segments with a fracture.
10
Q
How do radial head fractures and dislocations present during a physical examination?
A
- local swelling and tenderness
- limited/painful ROM (active and passive)
- painful/weak resistance testing (if administered)
11
Q
- Management of radial head fractures and dislocations involves monitoring for complications such as __________ compromise, healing failure, incision ________, etc.
- Early ___________ can be done in tolerable ranges.
- Progression from __________ (initiate ~3 weeks) to __________ training (5-6 weeks).
A
- neurovascular, infection
- mobilization
- isometrics to resistive training
12
Q
Monteggia Fracture:
- Dislocation of the proximal _______ (anterior, posterior, or lateral) and _____ fracture.
- Common MOI: Arm positioned in ____________ or ____________ with direct trauma or FOOSH.
- Check for concomitant __________ compromise; posterior branch of ______ nerve, ________ _________ nerve, ______ nerve (commonly present following _____).
A
- proximal radius and ulna fracture
- hyperextension or hyperpronation
- neurovascular compromise; radial, anterior interosseous, ulnar (commonly present following ORIF)
13
Q
What is the symptom of Monteggia Fracture?
A
local pain
14
Q
How do Monteggia Fractures present during physical examination?
A
- local swelling and tenderness
- limited/painful ROM (active and passive)
- painful/weak resistance testing (if administered)
15
Q
- Management of Monteggia Fractures involves monitoring for complications such as __________ compromise, healing failure, incision ________, etc.
- AROM initiated ~__ weeks post-op; extension >90 degrees usually held until ~__-__ weeks post-op.
A
- neurovascular, infection
- 4 weeks, 4-6 weeks
16
Q
Olecranon Fractures:
-Common MOI: trauma involving _______ contraction with flexion moment on elbow (fall on elbow, FOOSH) = __________.
A
- triceps
- avulsion
17
Q
What are the symptoms of an Olecranon Fracture?
A
- local elbow pain
- pain provoked with UE use during daily activities
18
Q
How will an Olecranon Fracture present during physical examination?
A
- local swelling, tenderness, palpable gap at olecranon
- absent/significant limitations with elbow extension (AROM, resistance)
19
Q
-Management of Olecranon Fractures if it is non-displaced involves ____________ while maintaining _______ function. Early (tolerable) ROM (pronation/supination after __-__ days, flexion/extension at ~__ weeks with limitations on flexion for ~__ months.
A
- immobilization
- tricep
- (2-3 days, 2 weeks, 2 months)
20
Q
If an Olecranon Fracture is treated via ORIF it is important to go through the surgeon __________, though early ____ is used.
A
- restrictions
- ROM
21
Q
PEDATRIC ELBOW AND FOREARM CONDITIONS
A
PEDATRIC ELBOW AND FOREARM CONDITIONS
22
Q
Nurse Maid’s Elbow:
- Dislocation of proximal _____ ____ (slips through _______ ligament).
- Incidence rate is __% in children <8 y/o and is more common in _____.
- Common MOI: ________ injury, traction on the pronated/extended forearm.
- Pain in forearm, wrist, and/or elbow.
A
- radial head (annular ligament)
- 3%, boys
- traumatic
23
Q
How will Nurse Maid’s Elbow present during a physical examination?
A
Painful, flaccid arm in pronated position
24
Q
Panner’s Disease (growth plate disorder):
- Osteochondritis; osteonecrosis of epiphysis
- Related to direct _________ or ________ changes
- Common age range __-__ years
- _____ more commonly affected (90%)
A
- trauma or vascular changes
- 5-16 years
- males (90%)
25
What is a symptom of Panner's Disease?
lateral elbow pain
26
How will Panner's Disease present during a physical examination?
- local swelling and tenederness
- limited/painful ROM (active and passive); possibly hard end-feel with fragmentation
- painful/weak resistance testing (if administered)
27
- Management of Panner's Disease involves _____ modification and possibly ________.
- ____/________ progression based on pt tolerance.
- activity, splinting
| - ROM/resistive
28
Osteochondritis Dessecans Capetellum:
- Pathomechanics are poorly understood but thought to be due to either a focal _______ injury f/b necrosis or possibly compression of ___________ joint.
- Commonly ___________ onset.
- C/o diffuse lateral elbow pain/"stiffness"
- locking/clicking/popping/catching
- Tenderness at _____________ joint.
- Diminished ________ ROM.
- Painful _________/__________.
- Painful _________ testing.
- Imaging: _______ of capitellum, _____ bodies
- arterial, humeroradial
- insidious
- humeroradial
- extension
- pronation/supination
- resistive
- flattening, loose
29
ELBOW INSTABILITY
ELBOW INSTABILITY
30
What are some common MOIs for elbow instability?
- Acute trauma (FOOSH with/out rotary force)
| - Microtrauma (overhead throwers/repetitive throwers)
31
What are some history risk factors that increase the likelihood of elbow instability?
- prior elbow dislocation
| - repetitive throwing with stress during mid-flexion of elbow
32
Will patients with elbow instability present with clicking/popping/clunk/locking/catching?
Yes, through extension AROM
33
What positive tests indicate elbow instability?
+ Moving Valgus Stress Test
| + Varus and/or Valgus Stress Test
34
MCL Sprain common MOI?
- attenuation of valgus/ER force
| - tennis/overhead throwing/FOOSH
35
What is the symptom of MCL sprain?
medial elbow pain
36
How will a patient with a MCL sprain present during a physical examination?
- tenderness MCL, local swelling
- + valgus stress testing (painful/excessive motion with testing)
- + Moving Valgus Stress Test
- Painful/limited elbow ROM
37
LCL Sprain common MOI?
-axial compression, ER, valgus force on elbow
38
What is the symptom of LCL sprain?
lateral elbow pain
39
How will a patient with a LCL sprain present during a physical examination?
- painful/limited elbow AROM/PROM
- local swelling
- tenderness LCL
- + Varus stress testing (painful/excessive motion with testing)
40
OLECRANON BURSITIS
OLECRANON BURSITIS
41
Olecranon bursitis is swelling/inflammation to the _________ bursa.
olecranon
42
What are things that can cause olecranon bursitis?
- prolonged w/b through UEs
| - trauma/fall onto elbow
43
What is the symptom of olecranon bursitis?
painful posterior elbow
44
How will a patient with olecranon bursitis present during physical examination?
- observable focal swelling
| - pain with AROM elbow, passive flexion painful
45
With olecranon bursitis, we should MONITOR FOR SIGNS OF ___________.
INFECTION (septic bursitis)
46
TENDONOSES OF THE ELBOW AND FOREARM
TENDONOSES OF THE ELBOW AND FOREARM
47
Distal Biceps Tendinopathy is likely a result of elbow hyper __________ or repetitive _______ with stressful pronation/supination.
- extension
| - flexion
48
What is the symptom for Distal Biceps Tendinopathy?
pain anterior to distal upper arm
49
How will a patient with Distal Biceps Tendinopathy present during a physical examination?
- tenderness to palpation
- AROM/PROM pain at end range shoulder/elbow extension
- Resistive testing painful flexion and supination
50
A Distal Biceps Tendon Rupture can be a progression from _________ and is most likely in ______ in the ____ decade.
- tendinosis
- males
- 5th
51
What are some common MOI for Distal Biceps Tendon Ruptures?
- significant extension moment with elbow flexed 90 degrees
| - strong biceps contraction
52
How will a patient with Distal Biceps Tendon Rupture present during a physical examination?
- Weakness/pain with active/resisted elbow flexion or forearm supination
- Ecchymosis distal biceps insertion
- Palpable defect/tenderness
- + Biceps Squeeze Test
53
Triceps Tendinopathy involves repetitive elbow ___________.
extension
54
What is the symptom for Triceps Tendinopathy?
posterior elbow pain
55
How will a patient with Triceps Tendinopathy present during a physical examination?
- AROM/PROM painful flexion at end range
- Resistive testing painful extension
- Tender locally
56
- A Triceps Rupture is a possible progression from tendinopathy but is _____.
- What is a common MOI for a Triceps Tendon Rupture?
- rare
| - sudden strong triceps contraction with elbow flexion motion (FOOSH)
57
Lateral Epicondylopathy is a tendinopathy of what? Most common origin where?
- common wrist extensor tendon
| - most common ECRB, ECRL, ECU, EDC origin
58
Difference between -itis, -opathy, -algia?
- itis = inflammation (acute)
- osis = chronic
- algia = pain at
59
-Lateral Epicondylopathy is __x more likely than medial epicondylopathy. Its prevalence is __-__% and is most common at __-__ y/o.
- 7x
- 1-3%
- 35-50 years
60
What are symptoms of Lateral Epicondylopathy?
- lateral elbow pain
| - aggravation with gripping
61
What are some common MOI of Lateral Epicondylopathy?
repetitive grasping/throwing
62
How will a patient with Lateral Epicondylopathy present during a physical examination?
- tenderness bulk of extensor muscle bellies, common extensor tendon
- painful tensile loading of extensor units (wrist flexion,elbow extension)
- painful resistive testing (wrist/finger extension (esp 3rd digit)) and radial deviation
- + Cozen's Test
- + Resisted Tennis Elbow Test
- + Passive Tennis Elbow Test
63
Medial Epicondylopathy is a tendinopathy of what?
| What is it also called?
- common flexor tendon
| - Golfer's elbow
64
What is a common MOI of Medial Epicondylopathy?
-microtrauma (f/b infiltration of fibrotic tissues)
65
How will a patient with Medial Epicondylopathy present during a physical examination?
- tenderness at common wrist flexor tendon, FCR, pronator teres, PL, FCU, FDS
- painful A/PROM wrist extension/supination
- painful resistive testing with wrist flexion/pronation
66
UE NERVE ENTRAPMENTS
UE NERVE ENTRAPMENTS
67
Cubital Tunnel Syndrome is an entrapment of the ________ nerve as it runs between what?
- ulnar nerve
| - between the medial epicondyle and the olecranon, cubital retinaculum or between the two heads of FCU
68
What will patients commonly report with Cubital Tunnel Syndrome?
- swelling
- arthritic changes
- trauma
- job requiring prolonged elbow flexion
- elbow varus/valgus abnormality
- overhead athletes
69
What muscles may be weakened with Cubital Tunnel Syndrome?
FCU, ulnar half of FDP, adductor pollicis hypothenar muscles, interossei, 3rd and 4th lumbricals
70
How will sensation present with Cubital Tunnel Syndrome?
pain/parasthesia in medial elbow and forearm into medial hand/digits
71
What tests may be positive if a patient has Cubital Tunnel Syndrome?
- + Tinel's sign
- + Pressure provocation test
- + Elbow flexion test
72
Patients with Cubital Tunnel Syndrome may present with a ___-_____ posture.
claw-hand (MP joints hyperextended and the IP joints flexed)
73
Guyon's Canal entrapment is an entrapment of the ______ nerve as it runs between what?
- ulnar
| - between pisiform and hook of hamate
74
What will patients commonly report with Guyon's Canal Entrapment?
- ulnar artery aneurysm or thrombosis
- carpal ganglia
- hamate fracture
- blunt trauma
- pneumatic jack hammer use
- use of crutches
75
What muscles may be weakened with Guyon's Canal Entrapment?
hypothenar muscles, adductor pollicis, interossei, medial 2 lumbricals
76
How will sensation present with Guyon's Canal Entrapment?
Sensory chagnes to only the 5th and medial 1/2 of the 4th digit
77
Pronator Teres Syndrome is an entrapment of the ________ nerve where?
- median
| - lacertus fibrosus, pronator teres, or FDS
78
What is the symptom for Pronator Teres Syndrome?
pain in proximal anterior forearm
79
Pronator Teres Syndrome is __x more likely in ______, and more common in the ___ decade.
- 4x more likely in women
| - 5th decade
80
What muscles may be weakened with Pronator Teres Syndrome?
abductor pollicis brevis, opponens pollicis, flexor pollicis brevis/longus, FDP of 2nd and 3rd digits, pronator quadratus, FCR
81
How will sensation present in Pronator Teres Syndrome?
lateral 3.5 digits and palm
82
How can we reproduce symptoms of Pronator Teres Syndrome?
- pronation with forearm neutral and gradual ext of elbow (PT)
- elbow flexion at 120-130 degrees elbow flexion and max supination
- PIPJ of 2nd digit (FDS)
- direct commpression at pronator teres
83
Anterior Interosseous Nerve Syndrome is a compression of the deep head of the pronator teres, FDS, accessory head of the FPL, palmaris profundus origin, accessory lacertus fibrosus. It will only present with ______ impairments, not _______ impairments.
- motor
| - sensory
84
What is the symptom of Anterior Interosseous Nerve Syndrome?
pain in proximal forearm
85
What muscles may be weakened with Anterior Interosseous Nerve Syndrome?
flexor pollicis longus, FDP of 2nd and 3rd digits, and pronator quadratus
86
What is the OK sign of Anterior Interosseous Nerve Syndrome?
When making an OK sign, we will see a hyperextension of the DIPJ 2nd finger and use of lateral portion of the 1st IPJ with a pinch grip
87
Carpal Tunnel Syndrome is a compression of the _______ nerve and with this we will see provocation with wrist movements and symptoms increase at ________.
- median
| - night
88
In Carpal Tunnel Syndrome, _________ hands improves hand paresthesia/anesthesia.
shaking (TayTay sign)
89
What muscles may be weakened with Carpal Tunnel Syndrome?
abductor pollicis brevis, opponens pollicis, flexor pollicis brevis, lumbricals (lateral 2)
-LOAF muscles
90
How will sensation present in Carpal Tunnel Syndrome?
lateral 3.5 digits
91
What tests may be positive when looking at Carpal Tunnel Syndrome?
- + Tinel's at the carpal tunnel
- + Phalens Test
- + Median Nerve Compression Test
92
What are some hand deformities that can be seen?
- Ape Hand Deformity
- Bishop's Hand Deformity
- Claw Hand Deformity
- Saturday Night Palsy
93
- What is ape hand deformity?
| - What do they have the inability to perform?
- Paralysis of the thenar muscles secondary to median nerve injury causes the EPL to drift the thumb medially and posteriorly.
- Opposition
94
What is Bishop's Hand Deformity?
Ulnar Nerve Injury (vs. Median Nerve*)
- If we see when trying to open the hand, extensors are lacking and ulnar nerve is involved.
- If seen when trying to close the hand, flexors are lacking and median nerve involved.
95
What is a Claw Hand Deformity?
- Ulnar and median nerve or inferior roots of brachial plexus injured.
- Intrinsic weakness
- Long extensors hyperextend the MCPJs, long flexors flex the PIPJ and DIPJ
- Curvature of palm lost
96
What is Saturday Night Palsy?
- Wrist drop
| - Radial nerve compression in radial groove.
97
Erb's Palsy is commonly a birthing injury involving the superior portions of the _________ _________. This involves an area of convergence of C5 and C6 and we see loss of shoulder ERs and abductors, elbow flexors, and hand extensors. With this we see a sensory loss where?
- brachial plexus
| - lateral forearm
98
What is a classic sign of Erb's Palsy?
Waiter's Tip Deformity
- shoulder IR and adducted
- elbow extended
- wrist flexed
99
Klumpke's Palsy is associated with hyperabduction of the shoulder and involves the inferior portions of the ________ _______. This involves an area of convergence of C8 and T1 and we see loss of intrinsic hand musculature and ulnar flexors of the wrist/hand. With theis we see a sensory loss where?
- brachial plexus
| - medial forearm and hand
100
What is a sign of Klumpke's Palsy?
Claw Hand Deformity
